This study presents 1) new ultrastructural observations (showing varying degrees of swelling of sarcoplasmic reticulum, mitochondrial damage, dilatation of T tubules, lipid accumulation, myofibrillar lysis and interstitial fibrosis) made on myocardial biopsies from patients with congestive cardiomyopathy and chronic alcoholism, and 2) a comprehensive review of all cardiac morphologic changes produced by the acute and chronic ingestion of large amounts of alcohol alone and alcohol plus cobalt- containing compounds (cobalt-beer cardiomyopathy) in humans and experimental animals.